law

Proposed Missouri Amendment 3 on November Ballot Would Prohibit Abortion and Gender Transition Procedures for Minors

nancyvalko abortion, chemical abortions, conscience rights, culture, health care reform, law, medical, medical abortion, medical ethics, miscarriage, organ donation, pro-life, safeguards, transgender, transgender care

In a June 24, 2026 ACLU article titled “Fight for Abortion Rights Has Turned to States in Years Since Landmark Reproductive Rights Ruling, Breanna Diaz, writes that “Four years ago, the Supreme Court struck down the federal right to abortion. Since then, the fight has turned to the states.”

The ACLU also maintains that “Since the Supreme Court overturned Roe v. Wade four years ago in the Dobbs v. Jackson case that ended the federal right to abortion, people across the country have felt the fallout, especially in the South and Midwest. Many have had to travel long distances to obtain abortion care in other states. Some have been denied urgently needed care at hospitals. Others have even lost their lives because of abortion bans.”

Although not perfect, I am proud that my state of Missouri now has now has Amendment 3, the “Prohibit Abortion and Gender Transition Procedures for Minors Amendment“ is on the ballot in Missouri as a legislatively referred constitutional amendment on November 3, 2026.[1]

According to Ballotpedia:


A “yes” vote supports amending the Missouri Constitution to:
:repeal the constitutional right to reproductive freedom, which voters ratified in 2024 and prohibit abortions except in cases of “medical emergency, fetal anomaly, rape, or incest,” and permit abortions in cases of rape or incest only through 12 weeks of gestation; 
prohibit gender transition surgeries for minors, as well as the prescription or administration of cross-sex hormones or puberty-blocking drugs to minors, with an exception for treatments “unrelated to the purpose of a gender transition;” and make other changes.
A “no” vote opposes amending the Missouri Constitution, keeping the existing constitutional right to reproductive freedom, and not adding provisions that prohibit abortion and gender transition surgeries and procedures.

Ballotpedia states that:

“This amendment would repeal Amendment 3, which was passed by voters in 2024. It amended the state constitution, providing for the fundamental right to reproductive freedom, including abortion.

The amendment would then add a new section that would prohibit abortion, except in cases of medical emergency, fetal anomaly, rape, or incest. For cases of rape and incest, the abortion could only be performed before 12 weeks. It would prohibit abortions based on a fetal disability diagnosis, except in cases of fetal anomaly. It would require parental or guardian consent for minors seeking an abortion and prohibit fetal organ harvesting. The amendment would also provide for the ability of a woman to access healthcare in cases of miscarriage and ectopic pregnancy.[1]

State Sen. Brad Hudson (R-33), who supports HJR 73, said, “From constituents and individuals that I’ve been talking to about this issue, they want another opportunity to weigh in on this. They don’t feel like that they were given an option in Amendment 3 that accurately reflects who they are and where they are on the life issue.”[2]

Margot Riphagen, president and CEO of Planned Parenthood Great Rivers Action, who opposes the measure, said, “The majority of Missourians want to make their own decisions about health care without interference from prying politicians … We will not stand for more political games at the expense of the thousands of patients in Missouri who could finally access care they need without crossing state lines. Missouri voters will once again send a clear message that enough is enough.”[3]

Abortion is currently legal in Missouri up to the point of fetal viability, which is defined in Missouri law as “that stage of fetal development when the life of the unborn child may be continued indefinitely outside the womb by natural or artificial life-supportive systems.”[4]

and:

“Missouri was one of 14 states that placed a constitutional amendment on a ballot to amend the state constitution to provide for the right to an abortion. The first three states to pass these amendments were California, Michigan, and Vermont in 2022, the same year that Roe v. Wade was overturned following the Dobbs v. Jackson Women’s Health Organization U.S. Supreme Court decision. Out of the 14 states, voters passed right-to-abortion amendments in 11 of them, and rejected amendments in three — Florida, Nebraska, and South Dakota. After 2022, voters in one state — Nebraska — approved a measure to limit the timeframe during which an abortion can be performed.

With Missouri’s Amendment 3, this will be the first time voters will decide to repeal a right-to-abortion amendment.”

“The ballot measure would repeal Section 36 of Article I of the Missouri Constitution, and add a new section, Section 36a. The following underlined text would be added and struck-through text would be deleted”:

“Section 36(a).1. The state’s duty to protect public health and welfare includes protecting the integrity and ethics of the medical profession. The state’s interest in regulating the practice of medicine is even greater in areas of medical and scientific uncertainty or in areas that raise grave moral and ethical concerns, including abortion and gender transition procedures.

2. An abortion may be performed or induced upon a woman in cases of medical emergency, fetal anomaly, rape, or incest. In the case of abortions performed or induced in cases of rape or incest, the abortion may be performed or induced no later than twelve weeks gestational age of the unborn child.

3. The general assembly may enact laws that regulate the provision of abortions, abortion facilities, and abortion providers to ensure the health and safety of the pregnant mother. These laws shall include, but not be limited to, laws requiring physicians providing abortion care to have admitting privileges at a nearby hospital; laws requiring facilities where abortions are performed or induced to be licensed and inspected for clean and safe conditions and adequate instruments to treat any emergencies arising from an abortion procedure; laws requiring physicians to perform a sufficient examination of the woman to determine the unborn child’s gestational age and any preexisting medical conditions that may influence the procedure; and laws requiring ultrasounds to be performed only by physicians or licensed medical technicians.

4. No abortion shall be performed or induced upon a woman based on a prenatal diagnosis, test, or screening indicating a disability in an unborn child, except in cases of a fetal anomaly.

5. No public funds shall be expended for the purpose of performing, inducing, or otherwise assisting any abortion, except in cases of medical emergency, rape, or incest, as otherwise authorized by law.

6. Except in cases of a medical emergency in which consent cannot be obtained, no abortion shall be performed or induced upon a woman without her voluntary and informed consent, given freely and without coercion. In the case of a minor under the age of eighteen years who is not emancipated, no person shall knowingly perform or induce an abortion, except in cases of a medical emergency in which consent cannot be obtained, unless the attending physician has obtained:

(1) the written consent of the minor and a parent or legal guardian; and(2) documentation of the consent is retained in the minor’s medical record. Licensed medical physicians shall be required to provide women with medically accurate information. The general assembly may enact laws to provide for the right of a minor to consent to an abortion as granted by a court order.

7. Fetal organ harvesting after an abortion is not permitted under any circumstances.

8. A woman’s ability to access health care in cases of miscarriages, ectopic pregnancies, and other medical emergencies shall not be infringed by the state.

9. No gender transition surgeries shall be knowingly performed on children under eighteen years of age, and no cross-sex hormones or puberty-blocking drugs shall be knowingly prescribed or administered for the purpose of gender transition to children under eighteen years of age. The provisions of this section shall not apply to the use of such surgeries, drugs, or hormones to treat children born with a medically verifiable disorder of sex development or to treat any infection, injury, disease, or disorder unrelated to the purpose of a gender transition.

10. Any action challenging the validity of any state law relating to reproductive health care shall be brought in the Circuit Court of Cole County, Missouri. If a pleading, written motion, or other paper drawing into question the constitutionality of a state statute does not include the state, one of its agencies, or one of its officers or employees in an official capacity, the party bringing the action shall file a notice of constitutional question and serve it on the attorney general and the attorney general shall have the right to intervene in the litigation.

11. The general assembly shall have the authority to enact laws to carry out the provisions of this section.

12. As used in this section, the following terms mean:

(1) “Cross-sex hormones”, testosterone, estrogen, or other androgens given to an individual in amounts that are greater or more potent than would normally occur naturally in a healthy individual of the same age and sex;

(2) “Fetal anomaly”, a structural or functional abnormality in the unborn child’s gestational development that would make life outside the womb impossible;

(3) “Fetal organ harvesting”, collection of fetal tissue, organs, or fluids, including any biological material, for the purpose of selling or collecting for scientific purposes, but shall not include the utilization of fetal tissue, organs, or fluids to determine the cause or causes of any anomaly, illness, death, or genetic condition of the unborn child, the paternity of the unborn child, or for law enforcement purposes;

(4) “Gender transition surgery”, a surgical procedure performed for the purpose of assisting an individual with identifying with and living as a gender different from his or her biological sex;

(5) “Medical emergency”, a condition that, based on reasonable medical judgment, so complicates the medical condition of a pregnant woman as to necessitate the immediate termination of her pregnancy to avert the death of the pregnant woman or for which a delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman. A medical emergency shall include, but not be limited to, an ectopic pregnancy at any point following the diagnosis of such and treatment for a miscarriage;

(6) “Puberty-blocking drugs”, gonadotropin-releasing hormone analogues or other synthetic drugs used to stop luteinizing hormone secretion and follicle stimulating hormone secretion, synthetic antiandrogen drugs to block the androgen receptor, or any other drug used to delay or suppress pubertal development in children for the purpose of assisting an individual with a gender transition;(7) “Reasonable medical judgment”, a medical judgment that would be made by a reasonably prudent physician, knowledgeable about the case and the treatment possibilities with respect to the medical conditions involved.

13. All provisions of this section are severable. If any provision of this section is found by a court of competent jurisdiction to be unconstitutional or unconstitutionally enacted, the remaining provisions of this section shall be and remain valid.

It is expected that the vote will be close.

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Dead Donor Rule Violations Draw Federal Sanctions

nancyvalko brain death, brain injury, dementia, end-of-life, futility, law, medical ethics, organ donation

In an Aug.7, 2026 post by Thaddeus Mason Pope, JD, PhD, HEC-C on his Medical Futility blog titled Dead Donor Rule Violations Draw Federal Sanctions, he writes that:

“Most violations of the dead donor rule are not enforced. When they are, it is usually through state criminal law. But this week, we see federal government enforcement of the dead donor rule. ” (Emphasis added)

The U.S. Department of Health and Human Services decertified the Lexington, Kentucky-based organ procurement organization, Network for Hope, after the DHHS found “persistent patient safety failures,” including moving forward with harvesting the organs from TJ Hoover despite him being alive and later recovering. ” (Emphasis added)

In my February 6, 2026 blog “Two States Are Facing Challenges in Death Decisions Regarding Death Determination Errors and Assisted Suicide”, I quote Mr. Pope’s statement on death determination:

“In Kentucky, Thaddeus Pope states his January 29th blog, Death Determination Errors Addressed in New Legislation, that:

“The goal in death determination is 100% accuracy: zero false positives. So, it is regrettable that we need legislation to address roles and responsibilities when a patient who was determined and declared dead is not dead. But we now have such legislation. 

Kentucky H.B. 510 provides that “during any organ donation recovery, preservation, or procurement activity … a pause in procedure shall be initiated if any individual … reports on any of the following: (1) Observed or suspected change in neurological status; (2) Observed or suspected indication of life; or (3) Uncertainty regarding the accuracy or completeness of neurological status or death declaration assessments.” (Emphasis added)

The goal in death determination is 100% accuracy: zero false positives. So, it is regrettable that we need legislation to address roles and responsibilities when a patient who was determined and declared dead is not dead. But we now have such legislation. 

Kentucky H.B. 510 provides that “during any organ donation recovery, preservation, or procurement activity … a pause in procedure shall be initiated if any individual … reports on any of the following: (1) Observed or suspected change in neurological status; (2) Observed or suspected indication of life; or (3) Uncertainty regarding the accuracy or completeness of neurological status or death declaration.” (Emphasis added)

CONCLUSION

I agree with Mr. Pope.

I first began my questioning about brain death when I went to a patient’s room in our ICU and found a group of doctors around a patient who had just been removed from a ventilator.

When I questioned what they were doing, the doctors told me that they were checking to see if the patient was brain dead.

When I said that brain cells would be dying from a lack of oxygen after several minutes and making him worse, the doctors looked stunned and told me that “Greater minds than yours have worked this out”.

I later learned that a pregnant woman on a ventilator continued her pregnancy until birth, and about cases like Zack Dunlap and Jahi McMath who survived after being declared brain dead.

I also discovered that some mothers declared “brain dead” were able to gestate their babies for weeks or months to a successful delivery before their ventilators were removed and that there were many cases of “brain dead” people who lived for months or years and even grew proportionally and achieved puberty.

If the legal definition of brain death is “irreversible cessation of all functions of the entire brain, including the brain stem” (Emphasis added), these cases would seem to be impossible.

And when I served on a hospital medical ethics committee, I was horrified when one doctor found a less rigorous set of brain death tests at another local hospital and proposed that we adopt this standard so that more of our patients could be declared “brain dead” for organ donation.

Investigating further, I also found “near-miss” cases like Zach Dunlap’s. Zach Dunlap is a young man who was declared brain dead after an accident in 2007. Testing showed no blood flow to his brain, and he was being considered for organ donation when a relative discovered a physical response. Four months later, Zach was making plans to return to work. In an interview, he said he heard a doctor say he was dead and it “just made me mad inside”.

CONCLUSION

As I pointed out in my Spring 2016 NCBC Quarterly journal article titled “Brain Death: Do We Know Enough?” :

“When cases like those of Jahi McMath and Zack Dunlap who survived after being thought brain dead are routinely dismissed instead of rigorously investigated to establish the facts, medical certainty is not achieved and medical integrity is undermined. In addition, when hospitals set their own standards and policies for determining brain death without external accountability, lives—as well as the essential and necessary trust in the health care system—can and possibly will be lost.” (Emphasis added)

Personally, I am not against all organ donation.

In the past, I have offered to be a living donor for a friend who needed a kidney, watched my grandson cured of a rare disease through a bone marrow transplant, and I told my family that I wanted to donate my corneas and any other tissues that can be taken after natural death.

I am open to new facts, but until then, I refuse an apnea test or any other test to specifically determine brain death if I have a severe brain injury.

And I will not sign an organ donor card.”

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California is Suing Christian nonprofits that Help Women Save Their Unborn Babies

nancyvalko abortion, adoption, bereavement, chemical abortions, Compassion & Choices, conscience rights, culture, education, family, law, media, medical, medical ethics, nursing, Planned Parenthood, pro-life, safeguards

In a disturbing op-ed in the July 30, 2026 edition of the Wall Street Journal titled “California’s Case Against Second Chances,” Archbishop Salvatore of San Francisco and Bishop Michael C. Barber of Oakland write that “The State is suing Christian non-profits that help women save their unborn babies.”

The Bishops write:

“Elizabeth Barrett, a young college dropout in Southern California, swallowed a pill the local abortion clinic had given her—and then, almost immediately after, changed her mind. An online search for advice on how to undo the chemical abortion led her to Heartbeat International, a Christian nonprofit that refers women to licensed doctors for treatment. It worked. Ms. Barrett is the mother of a healthy girl.

The state of California wants to be sure that such things never happen again. In an extraordinary case now unfolding at trial in state court in Oakland, California’s attorney general seeks an injunction and up to $20 million in fines against Heartbeat International and another small pro-life Christian nonprofit, RealOptions. Their offense is telling women who regret swallowing the abortion pill that there is a medical treatment that can sometimes save their babies.

Consumer fraud, the prosecutors are calling it. Legal scholars call it an abuse of power. “This novel use of California’s commercial-fraud statute seems designed to intimidate nonprofit organizations that—with no hope of commercial gain—seek to educate the public about services that are lawful but contrary to the ideological preferences of the government,” says Michael McConnell, a professor who teaches free-speech law at Stanford.

California isn’t alone in attacking these Christian groups. New York’s Attorney General Letitia James has filed a similar lawsuit against Heartbeat International and other pregnancy centers. The Thomas More Society, a Catholic public-interest law firm, is pursuing separate federal cases challenging the constitutionality of these prosecutions in federal courts.

California’s attorney general has found no evidence that any woman has complained of harm by the defendants. That didn’t dissuade the state, which is marshaling its taxpayer-funded resources to shut these ministries down.

The state argues that because the nonprofits raise money from donors, they are engaged in commercial speech. If the government wins, doctors may still prescribe the medication, but no nonprofit can tell women the treatment exists—a novel legal theory that would vastly expand lawfare against those who hold views with which the government disagrees.

One wonders whether the pro-abortion lobby has really thought this through. The prosecution’s theory “would expose any nonprofit in America” to “the same government overreach,” Paul Jonna, an attorney from the Thomas More Society, said in a news release. Don’t they worry that some future state attorney general in Mississippi might use similar tactics to go after Planned Parenthood?

Reading the depositions of these women is a painful experience. To be a Catholic priest these days, as we both are, is to have heard many similar stories of women who felt pressured to have an abortion they didn’t want.

Everyone should oppose this. But these women especially need support from the religious—those who hold that creation in God’s image means life is endowed with a dignity that can’t be trampled by a government determined to punish those who oppose unquestioned abortion.

Consider just the case of Ms. Barrett. In 2023, she was struggling financially, and she and her live-in boyfriend were experiencing increasing strain in their relationship. When she learned she was pregnant, “I panicked at the thought of spending 18 years in family court,” Ms. Barrett testified. She “struggled to imagine where I would be able to find funds to cover child-care costs.”

At the clinic, she told staff she was scared and thought she might want to keep her baby, hoping to talk through her options. “I was a huge supporter and donor to Planned Parenthood at the time,” she said. “I thought for sure that staff at the clinic would help me out.” Instead they urged her to take the abortion pill that day and warned that if she delayed, she might not be able to get another appointment. “With that scheduling pressure and overwhelmed by misgivings about getting the abortion—what if I wanted to proceed but couldn’t later?—I took the first of two pills for a chemical abortion.”

But before she left the clinic, her boyfriend texted her saying he wanted to keep the baby and raise their child together. That changed everything. So began a frantic search for anything to stop the abortion: “I was desperate, borderline hysterical, and willing to try just about anything.” Ms. Barrett found Heartbeat International online. Within an hour, she had a clinic appointment with a licensed California doctor to reverse her abortion pill. She’s a mother today thanks to this Christian nonprofit and its donors.

California v. Heartbeat International and RealOptions is a rare case that should bring together both sides of the abortion debate. In particular, it tests the souls of those who claim the platform of “pro-choice.” What kind of people see a pregnant woman who wants to reverse the effects of an abortion pill and think, “Let’s punish the nonprofits that informed her she has a choice”?

Are they really pro-choice, or do they just like killing?

Archbishop Cordileone is archbishop of San Francisco. Bishop Barber is bishop of Oakland.“

CONCLUSION

It is not just abortion clinics, it is also about teleheath abortions.

As I wrote June 4, 2026,

New Lozier Study Shows Chemical Abortions Are Largely Unregulated

 nancyvalko abortion, chemical abortions, education, law, medical, medical abortion, medical ethics, Planned Parenthood, safeguards

As a new June 4, 2026, National Right to Life article by Michael New titled “New Lozier Study Shows Chemical Abortions Are Largely Unregulated” just reported:

“Last week, the Charlotte Lozier Institute released a study by research associate Mia Steupert showing that organizations selling chemical abortion pills online are largely unregulated. Specifically, these organizations often fail to comply with existing laws, FDA regulations, and basic health and safety standards. The study considered entities that provide telehealth abortions through the formal U.S. health-care system. The study also considered overseas and online entities that sell abortion pills.

Here are some of the specifics. The Lozier study identified 80 organizations that provide telehealth abortions through the formal U.S. health-care system. Thirty-eight of these organizations are online only, and 42 are hybrid brick-and-mortar and online facilities. Again, these facilities are technically subject to FDA regulations. The study, however, provides strong evidence that these facilities frequently violate FDA policies, states’ pro-life laws, and basic health standards:

  • Only 15 of 80 report they will adhere to FDA rules and not ship abortion pills to pregnant women after 70 days gestation.
  • 43 of the 80 either had no age requirement for the woman obtaining abortion pills or did not publish this information. This would put them in violation of state parental involvement laws.
  • Only 39 of the 80 formally required women to take part in a video call to discuss their eligibility for taking abortion drugs.
  • Only 9 of 80 require that all women submit a form of identification before obtaining abortion pills. One additional organization required a form of identification only from women living in certain states.
  • Only 16 of 80 require a virtual follow-up after the abortion has taken place.“

Since the Supreme Court’s Dobbs decision, unregulated telehealth abortions have posed a serious challenge to the pro-life movement. These telehealth abortions undermine and weaken many of the strong state-level pro-life laws that have been enacted post-Dobbs. This new Lozier study highlights the extent to which chemical abortions are largely unregulated, posing serious public health concerns. The study also details ongoing litigation where women unknowingly took chemical abortion pills because their partners wanted their pregnancies terminated. Had appropriate regulations and safeguards been in effect, these women and their preborn children would have been protected.

The Lozier study identifies several policy tools that could be used to ban or limit telehealth abortions. The FDA could restore the rules that existed before the COVID-19 pandemic and require women obtaining chemical abortions to have an in-person meeting with a health-care professional. Multiple lawsuits are being filed by various state attorneys general, arguing that the new rules violate the FDA’s Administrative Procedures Act. Finally, the Comstock Act, which prevents abortifacients from being sent through the mail, could be enforced.

This important Lozier study demonstrates that stopping telehealth abortions should remain a top priority for pro-lifers.

This appeared at National Review Online and is posted with the author’s permission.“

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s

s

New Lozier Study Shows Chemical Abortions Are Largely Unregulated

nancyvalko abortion, chemical abortions, education, law, medical, medical abortion, medical ethics, Planned Parenthood, safeguards

As a new June 4, 2026, National Right to Life article by Michael New titled “New Lozier Study Shows Chemical Abortions Are Largely Unregulated” just reported:

“Last week, the Charlotte Lozier Institute released a study by research associate Mia Steupert showing that organizations selling chemical abortion pills online are largely unregulated. Specifically, these organizations often fail to comply with existing laws, FDA regulations, and basic health and safety standards. The study considered entities that provide telehealth abortions through the formal U.S. health-care system. The study also considered overseas and online entities that sell abortion pills.

Here are some of the specifics. The Lozier study identified 80 organizations that provide telehealth abortions through the formal U.S. health-care system. Thirty-eight of these organizations are online only, and 42 are hybrid brick-and-mortar and online facilities. Again, these facilities are technically subject to FDA regulations. The study, however, provides strong evidence that these facilities frequently violate FDA policies, states’ pro-life laws, and basic health standards:

  • Only 15 of 80 report they will adhere to FDA rules and not ship abortion pills to pregnant women after 70 days gestation.
  • 43 of the 80 either had no age requirement for the woman obtaining abortion pills or did not publish this information. This would put them in violation of state parental involvement laws.
  • Only 39 of the 80 formally required women to take part in a video call to discuss their eligibility for taking abortion drugs.
  • Only 9 of 80 require that all women submit a form of identification before obtaining abortion pills. One additional organization required a form of identification only from women living in certain states.
  • Only 16 of 80 require a virtual follow-up after the abortion has taken place.“

Since the Supreme Court’s Dobbs decision, unregulated telehealth abortions have posed a serious challenge to the pro-life movement. These telehealth abortions undermine and weaken many of the strong state-level pro-life laws that have been enacted post-Dobbs. This new Lozier study highlights the extent to which chemical abortions are largely unregulated, posing serious public health concerns. The study also details ongoing litigation where women unknowingly took chemical abortion pills because their partners wanted their pregnancies terminated. Had appropriate regulations and safeguards been in effect, these women and their preborn children would have been protected.

The Lozier study identifies several policy tools that could be used to ban or limit telehealth abortions. The FDA could restore the rules that existed before the COVID-19 pandemic and require women obtaining chemical abortions to have an in-person meeting with a health-care professional. Multiple lawsuits are being filed by various state attorneys general, arguing that the new rules violate the FDA’s Administrative Procedures Act. Finally, the Comstock Act, which prevents abortifacients from being sent through the mail, could be enforced.

This important Lozier study demonstrates that stopping telehealth abortions should remain a top priority for pro-lifers.

This appeared at National Review Online and is posted with the author’s permission.“

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ABORTION PILLS HEAD TO THE SUPREME COURT

nancyvalko abortion, culture, education, law, medical abortion, medical ethics, nursing, pro-life, safeguards

In a May 7, 2026 article in First Things by Jonathan Van Maren titled “Abortion Pills Head to the Supreme Court” , Mr. Von Maren states:

“Two judicial rulings over Mifepristone this month have set the stage for the most important legal battle over abortion since the overturn of Roe v. Wade in 2022—and the fight has exposed the growing divide between the pro-life movement and the Trump administration.

He explains:

“Central to this legal battle is the Biden administration’s decision to use the pretext of the COVID pandemic to temporarily suspend the requirement that abortion pills be dispensed in person by a certified healthcare provider or clinic in 2021; the change was made permanent in 2023. This created a massive mail-order market that has sent abortion pills flowing into states with pro-life laws, triggering a series of lawsuits. 

Louisiana launched a lawsuit last year challenging the Food and Drug Administration’s 2023 decision and arguing that the changes both lacked sufficient safety data and enable illegal abortions in their state, which has some of the most comprehensive pro-life protections in the country. 

On May 1, the U.S. Court of Appeals for the Fifth Circuit agreed with Louisiana that the mail-order abortion pills coming across state lines were a violation of the state’s pro-life laws. The court issued a temporary stay order in State of Louisiana v. FDA, reinstating the FDA’s pre-2021 requirement. The decision paused mail-order access to abortion drugs across the country.

“Every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is [a] human being from the moment of conception and is, therefore, a legal person,’” the court’s decision states. The decision also notes that the FDA has admitted “it had failed to adequately study whether remotely prescribing mifepristone is safe,” and that Louisiana’s case was “strong.” 

Two pharmaceutical companies that produce the abortion pill, Danco Laboratories and GenBioPro, swiftly petitioned the Supreme Court for emergency relief to restore access to the drugs, arguing that the stay would create chaos. On May 4, Justice Samuel Alito issued an administrative stay of the Fifth Circuit’s order, temporarily restoring telehealth and mail-order access until at least May 11 as the Supreme Court considers the case further.

Pro-life leaders have been exultant about the Fifth Circuit’s decision and optimistic that the Supreme Court’s administrative stay will be ultimately temporary. “Women and children suffer and state sovereignty is violated every day the FDA allows abortion drugs to flood the mail—harms that are no mere accident, but predictable outcomes of the FDA’s unscientific removal of safeguards like in-person doctor visits,” stated Marjorie Dannenfelser of Susan B. Anthony Pro-Life America.

In response to the Supreme Court’s stay, Alliance Defending Freedom—which joined Louisiana’s challenge to the FDA—was emphatic. “This is NOT a reversal of Friday’s decision,” ADF said in a statement. “Rather, it’s the run-of-the-mill pause that the Justices typically use to consider the issues raised in an emergency application. . . . We respect the Court’s desire to have time to consider the issues and will continue our fight to uphold this victory.”

Repealing the FDA’s 2023 change has become the pro-life movement’s primary goal since Dobbs. Thirteen states have strong pro-life protections for unborn children, but mail-order abortion pills have essentially nullified these protections; according to the Guttmacher Institute, 63 percent of abortions in 2023 (the latest year for which national data is available) were pill abortions. The abortion rate is rising for the first time in decades, and a quarter of abortions are facilitated by telehealth services.

Despite this, the second Trump administration has actively opposed the pro-life movement’s attempts to restore the pre-2021 status quo. The Trump Department of Justice has continued the Biden policy of defending the FDA against state-led lawsuits against the abortion pill, asking for dismissals or pauses as the FDA conducts a safety review of mifepristone. In the meantime, the Trump administration approved another generic abortion pill in October 2024. 

In sharp contrast to the strong record of the first administration, Trump’s approach this time around has been to keep the pro-life movement in the tent but off the platform. In 2024, the Trump campaign stripped the pro-life plank out of the GOP platform for the first time in decades; during the campaign, Trump stated that he supported access to the abortion pill. Vice President JD Vance has attended the March for Life twice to shore up support, but pro-life leaders long muted in their criticisms are now openly expressing their frustration with the administration. 

“Restore the in-person dispensing by a doctor of these drugs!” Dannenfelser told a protest outside the HHS department in January. “What a modest thing to do for the women and children of America. Restore that to the Trump 1 policy! The Biden COVID-era abortion drug policy has led to devastating moments of death for children and coercion and death for women. . . . Abortions have gone up since Dobbs, not down!”

She was blunter speaking to the Wall Street Journal last week. “Trump is the problem. The president is the problem.”

CONCLUSION

I have been writing about the dangers of the abortion pills in posts like the February 16, 2017, post “Are Mail Order Abortions Coming? my September 21 2019 post “Press Release: The National Association of Pro-life Nurses On Federal Judge Blocking North Dakota Law Informing Women of Abortion Pill Rescue Reversal” and my February 26, 2026, post “Safer Than Tylenol” is Deliberate Medical Abortion Disinformation.

Especially as nurses, we need to inform the public!

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Physician Group Opposes Youth Gender Transition Surgery— Plastic surgeons support waiting until patients are at least 19 years old

nancyvalko AMA, culture, health care reform, law, media, medical ethics, transgender, transgender care

In a stunning February 3, 2026 Medpage article “Physician Group Opposes Youth Gender Transition Surgery” by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today reports:

“For the first time, a major U.S. physician group has recommended against gender transition surgeries for youths.

On Tuesday, the American Society of Plastic Surgeons (ASPS) sent a position statement to its 11,000 members recommending against gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.”

and

ASPS said its understanding has evolved in light of “additional comprehensive evidence reviews” on gender dysphoria, including an HHS report that was issued last May. Both the HHS report and the U.K.’s Cass Review concluded that the “natural course of pediatric gender dysphoria remains poorly understood,” according to the position statement.

“The HHS report underscores that this uncertainty has significant ethical implications: when the likelihood of spontaneous resolution is unknown and when irreversible interventions carry known and plausible risks, adhering to the principles of beneficence and non-maleficence … requires a precautionary approach,” the statement said.

ASPS emphasized that its advice comes in the form of a policy statement, not a clinical practice guideline, given the “current state of the evidence and variability in legal and regulatory environments.”

It also advised its members to “remain aware of state laws concerning transgender and gender-diverse individuals that may impact their practices,” as many states have banned gender-affirming care in youths.

The ASPS statement comes just a few days after a jury in New York awarded $2 million to a patient who had accused her psychologist and plastic surgeon of failing to obtain adequate consent before performing a double mastectomy on her when she was a teenager. It’s the first malpractice verdict against providers of youth gender care.” (Emphasis added)

She also writes that:

“The position statement breaks with other major medical associations in the U.S., most notably the American Academy of Pediatrics (AAP) and the Endocrine Society, which support gender-affirming care. It’s also a departure from ASPS’s past stance in 2019, which was that gender surgery can help patients improve their mental health, according to the Washington Post.

The American Medical Association said in a statement that it supports evidence-based treatment, including gender-affirming care. The association agreed with ASPS in part, but stopped short of saying surgeries should be deferred to adulthood in all cases.

“Currently, the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement,” the group said in a statement. “In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.”

However,

“The World Professional Association for Transgender Health (WPATH), which develops standards of care for transgender patients globally, reiterated its support for access to surgical care for minors under “cautious guidelines and criteria.”

The group’s guidelines oppose a “definitive age or ‘one-size-fits-all’ approach for every patient.” Decisions should be case-by-case, based on the evaluations of multiple types of health experts and experts in adolescent development.

“WPATH stands firm in its commitment to advancing evidence-informed clinical guidelines to help improve the lives and well-being of transgender people around the world,” the group said in a statement.

and:

“AAP president Andrew Racine, MD, PhD, said his organization “does not include a blanket recommendation for surgery for minors” with gender dysphoria. “The AAP continues to hold to the principle that patients, their families, and their physicians — not politicians — should be the ones to make decisions together about what care is best for them.”

Fewer than 1,000 children under age 19 receive gender surgery in the U.S. each year, and the vast majority of those cases are mastectomies, according to a 2023 cohort study.

CONCLUSION

As the Medpage article states:

Nonetheless, the Trump administration has been cracking down on gender-affirming care in the U.S., through the HHS report, as well as through proposed CMS rules that would prohibit hospitals from performing gender surgeries for people under 18 as a condition of participation in Medicare and Medicaid programs.

HHS issued a press release supporting the ASPS position statement, with Secretary Robert F. Kennedy Jr. congratulating the group for “standing up to the overmedicalization lobby and defending sound science.”

CMS Administrator Mehmet Oz, MD, also applauded the move: “When the medical ethics textbooks of the future are written, they’ll look back on sex-rejecting procedures for minors the way we look back on lobotomies. I applaud the American Society of Plastic Surgeons for placing itself on the right side of history by opposing these dangerous, unscientific experiments.”

This will continue to be a hot topic.

What do YOU think?

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Two States Are Facing Challenges in Death Decisions Regarding Death Determination Errors and Assisted Suicide

nancyvalko advance directives, assisted suicide, brain death, civil rights, conscience rights, end-of-life, law, Living wills, medical, medical ethics, mental health, organ donation, suicide

Delaware and Kentucky are facing challenenges to lasws r4gatding end of life deicisions.

In Kentucky, Thaddeus Pope in his January 29th blog Death Determination Errors Addressed in New Legislation states:

“The goal in death determination is 100% accuracy: zero false positives. So, it is regrettable that we need legislation to address roles and responsibilities when a patient who was determined and declared dead is not dead. But we now have such legislation. 

Kentucky H.B. 510 provides that “during any organ donation recovery, preservation, or procurement activity … a pause in procedure shall be initiated if any individual … reports on any of the following: (1) Observed or suspected change in neurological status; (2) Observed or suspected indication of life; or (3) Uncertainty regarding the accuracy or completeness of neurological status or death declaration assessments.” (Emphasis added)

The goal in death determination is 100% accuracy: zero false positives. So, it is regrettable that we need legislation to address roles and responsibilities when a patient who was determined and declared dead is not dead. But we now have such legislation. 

Kentucky H.B. 510 provides that “during any organ donation recovery, preservation, or procurement activity … a pause in procedure shall be initiated if any individual … reports on any of the following: (1) Observed or suspected change in neurological status; (2) Observed or suspected indication of life; or (3) Uncertainty regarding the accuracy or completeness of neurological status or death declaration.”

And in Delaware, a lawsuit has been filed by several disability organizations and others, after the bill was signed by the governor and took effect January 1, 202. the plaintiffs state that:


  1. Delaware’s End of Life Options Act, 16 Del. C. § 2501C, et seq. (“EOLOA” or the
    “Act”), is scheduled to go into effect on January 1, 2026 (or as soon as final regulations are in
    place), and will allow providers, including Advanced Practice Registered Nurses (“APRN”), to
    prescribe drugs—not to alleviate pain or suffering—but to cause the death of the patient and
    intentionally facilitate suicide.

  2. Plaintiffs, people with life-threatening disabilities and organizations that represent
    and advocate for people with life-threatening disabilities, belong to a class of protected individuals
    who are at imminent risk of harm if the Act is allowed to go into effect. To protect themselves
    from this fast-approaching threat, Plaintiffs bring this action to stop Defendants, government
    officials, from putting in place this deadly and discriminatory system. The Act—if allowed to go
    into effect—will steer people with life-threatening disabilities away from necessary lifesaving and
    mental health care, medical care, and disability supports, and toward death by suicide under the
    guise of “mercy” and “dignity” in dying.

  3. Throughout the country, a state-endorsed narrative is rapidly spreading that threatens people with disabilities: namely, that people with life-threatening disabilities should be directed to suicide help and not suicide prevention. This world view is being touted as a common-sense objective: people who have life-threatening disabilities should be able to readily obtain physician-assisted suicide. At its core, this is discrimination plain and simple. With cuts in healthcare spending at the federal level, persons with life-threatening disabilities are now more vulnerable than ever.

  4. EOLOA’s passage is clear and present danger to people with life-threatening
    disabilities in Delaware. Persons who are identified as “terminal”—i.e., people with life-threatening disabilities- are able to obtain assisted suicide. The new law does not require any evaluation, screening, or treatment by a mental health professional for serious mental illness, depression, or treatable suicidality, all of which could are necessary for informed consent and a
    truly autonomous choice, before the lethal prescription is written. The provider need not have
    expertise with the patient’s specific illness or condition and need not be trained on mental health
    symptoms or side effects associated with the patient’s illness or treatment. While the provider is
    supposed to discuss “feasible” alternatives to suicide, including available treatment options and
    the foreseeable risks and benefits of each, the provider is not required to do anything to help the
    patient obtain access to these frequently difficult to obtain services, nor are insurers required to
    cover them.
  1. Assisted suicide under EOLOA violates federal disability rights laws and the U.S.
    Constitution’s Equal Protection clause, which protects people with disabilities from discrimination,
    exclusion, and life-threatening state action. Under federal law, a public entity may not withhold
    services or make services available on unequal terms based on disability. EOLOA, however, does
    just that. EOLOA is offered to people with life-threatening disabilities. Not only is this facially
    discriminatory, it also places persons with disabilities in a much more vulnerable position.

The lawsuit makes several other important points. I suggest anyone concerned with this issue read them all, especially those of us fighting assisted suicide laws.

Forgiveness is a Decision, Not a Feeling

nancyvalko faith, faith and forgiveness, law, mental health, pro-life

I was shocked when I turned on the tv September 10, 2025 and saw the assassination of Charlie Kirk, the founder of Turning Point USA, on September 10, 2025 debate while speaking at Utah Valley University on the first stop this fall of his “The American Comeback Tour,” which invited students on college campuses to debate hot-button issues.

I admired the 31-year-old’s efforts to engage college students and others in open and respectful debate about some of the most divisive issues roiling politics today.

As Emily Standley Allard wrote for MSN:

“(h)e built a political platform that resonated deeply with young conservatives while provoking equally strong opposition from progressives.

Kirk presented himself as a combatant in America’s culture wars, speaking directly to students, churchgoers, and millions of podcast listeners about what he considered existential battles over freedom, faith, and America’s future. “

Since then, his wife, Erica Kirk, has become the head of Turning Point USA while raising their two young children.

Erica Kirk’s Response to Her Husband’s Murder

As The Hill reported:

“I’ve had so many people ask, ‘Do you feel anger toward this man? Like, do you want to seek the death penalty?” Kirk said. “I’ll be honest. I told our lawyer, I want the government to decide this. I do not want that man’s blood on my ledger.”

Kirk reiterated that message during her eulogy on Sunday. The 36-year-old received a lengthy standing ovation when she was called to the stage, and was emotional throughout her remarks.”

“Erika Kirk, the widow of Charlie Kirk, said Sunday that she forgives the man accused of killing her husband.

“On the cross, our savior said, ‘Father, forgive them. For they do not know what they do.’ That man. That young man. I forgive him,” Erika Kirk said at her husband’s memorial, with her voice softening and tears streaming down her face.

“The answer to hate is not hate,” she said. “The answer we know from the Gospel is love, and always love.”

CONCLUSION

Erica Kirk’s forgiveness of her husband’s killer shocked many people, but I understand the power of forgiveness.

In 1983, we lost a daughter with Down syndrome and a severe heart defect, and my husband had a breakdown and was hospitalized several times.

I thought he was getting better, but in 1987, my three children and I returned home from church, and he was gone. I discovered that he had taken all our money and fled to Illinois.

Our 10-year-old son was devastated and said, “I will never forgive him!”

I told him that he will and he must. He was shocked and asked me if I could forgive him.

“I already have”, I told him.

I explained that forgiveness is a decision, not a feeling, and that refusing to forgive his father would hurt him more. Faith and forgiveness would heal all of us.

It was a difficult time for all three children with a divorce, selling our house, moving to another home, and the children going to new schools- not to mention my having to go back to working as a nurse because Missouri did not cross state lines to enforce child support.

However, I did allow the children to visit with their father with a guardian supervising.

I was so happy when my son eventually told me that he was starting to feel forgiveness in his heart! He was healing!

Although my ex-husband never got better mentally and eventually died, we visited him in his last days, and that was a blessing for all of us!

Thank you, Erica Kirk, for your example of faith and forgiveness!

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Proposed Missouri Amendment 3 on November Ballot Would Prohibit Abortion and Gender Transition Procedures for MinorsSeptember 26, 2026nancyvalko
About Nancy Valko, RN ALNCJune 18, 2015nancyvalko
The World Brain Death Project: What It MeansAugust 11, 2020nancyvalko

New Dementia Directive Developed to Avoid Late-Stage Dementia

nancyvalko advance directives, Alzheimer's, assisted suicide, Cancer, culture, dementia, end-of-life, euthanasia, food and water, law, medical, medical ethics

In the September 25, 2025, issue of the Journal of Law, Medicine and Ethics, there is a shocking article titled “New VSED Advance Directive: Improved Documentation to Avoid Late-Stage Dementia.” VSED means voluntary stopping of eating and drinking.

The authors state:

“People use advance directives to express preferences that direct their future care when they lack decision-making capacity. One form of advance directive, a “dementia directive,” records preferences about living in various stages of dementia. This is important because many Americans want to avoid living with advanced progressive dementia. Unfortunately, traditional advance directives cannot dependably achieve this goal. In contrast, some dementia directives can achieve this goal by directing cessation of manually assisted feeding and drinking. (Emphasis added)

We proceed in six stages. First, we review the prevalence of advanced dementia. Second, we identify the disadvantages of another option for accomplishing the goal of not living into advanced dementia, preemptive VSED. Third, we distinguish notable court cases where dementia directives were unsuccessful. Fourth, we review nine prominent dementia directives, noting how the Northwest Justice Project’s Advance Directive for VSED remedies those shortcomings. Fifth, we review this directive’s legal status. Sixth, we articulate its ethical justification.”

CONCLUSION

I have had a lot of experience caring for people with Alzheimer’s, both personally and professionally. I have written several blogs over the years, such as “Five Things my Mother (and Daughter) Taught Me about Caring for People with Dementia” (2016), Marketing Death and Alzheimer’s Disease (2019), and Alzheimer’s Association Ends Agreement with Compassion and Choices, Marketing Death and Alzheimer’s Disease (2023). In 1988, I wrote an op-ed published in the St. Louis Post-Dispatch titled “FEEDING IS NOT EXTRAORDINARY CARE– DECISION IN THE NANCY CRUZAN CASE ADDS TO THE LIST OF EXPENDABLE PEOPLE“

I remember when my mother was first diagnosed with Alzheimer’s and thyroid cancer. She needed a tracheostomy (a tube in her windpipe), but was able to eat by mouth.

I was shocked when one doctor asked if we wanted her fed, and I responded angrily, “She gets up and eats ice cream out of the refrigerator! Do you want me to tackle her?!”

Of course, I knew what he meant, but he got the message.

Eventually, my mother died peacefully in her sleep at a nursing home after enjoying a meal and laughter with the whole family. It was the kind of death she told me she wanted.

Unfortunately, my younger brother developed Alzheimer’s and diabetes and was critically injured in a fall down the stairs last October. I was able to calm him and carefully feed him.

The doctor recommended a feeding tube to ensure he was getting adequate nutrition, especially for his diabetes.

However, a palliative care team was called in and disagreed with the doctor, telling my sister-in-law that my brother was not going to get better anyway.

I explained to the family that a small feeding tube was available and comfortable, but the family rejected that option.

It took several long days for him to die.

No wonder assisted suicide is being considered for Alzheimer’s patients!

Abortion pills: Where are they legal and illegal?

nancyvalko abortion, Drugs, education, law, medical abortion, miscarriage, nursing, pro-life

In a January 8, 2025, article by the Catholic News Agency titled Abortion pills: Where are they legal and illegal?, author Jonah McKeown writes:

“As states continue to legislate on abortion in the post-Roe v. Wade landscape, a major point of contention as a new presidential administration takes office is the two-drug medication abortion regimen, commonly referred to as the abortion pill.

Abortions done via medication, also called chemical abortions, currently account for about half of the abortions that are done in the United States every year. However, many states restrict the use of abortion pills, specifically the first drug in the two-drug regimen, mifepristone. (Emphasis added)”

Take a look at the map below to see where abortion pills are legal, and where they aren’t:

Green is illegal, yellow is limited, and red is legal (go to Abortion pills: Where are they legal and illegal? to click on each state’s specific law)

As the author states:

“At the federal level, mifepristone is approved to abort an unborn child up to 10 weeks’ gestation, having been first approved for such use in 2000. 

The drug kills the child by blocking the hormone progesterone, which cuts off the child’s supply of oxygen and nutrients. A second pill, misoprostol, is taken between 24 to 48 hours after mifepristone to induce contractions and expel the child’s body.

Several states, most of which have some pro-life laws in place, have also passed restrictions on abortion pills designed to protect women, including requirements that only physicians may dispense them. These states include Alaska, Arizona, Florida, Georgia, Iowa, Michigan, Nebraska, Nevada, North Carolina, Ohio, Pennsylvania, South Carolina, and Utah. (Emphasis added)”

and

“A large number of states — most of them concentrated in a contiguous cluster in the South and Midwest — ban abortion in most cases but provide exceptions in cases where the life of the mother is at risk or in cases of rape, incest, or fetal anomaly. In these states, access to abortion pills is likely to be very limited or prohibited entirely. 

States with total bans on abortion pills include Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, and Texas. “

However, as Mr. McKeown. also writes,

” just because these states have bans on abortion pills in place does not mean the drugs are not accessible; women in those states can still receive them in the mail. Under then-President Donald Trump during the COVID-19 pandemic in 2020, the FDA was given the ability to distribute the drug via mail. The administration of President Joe Biden eventually solidified the practice as a norm in 2023. (Emphasis added)

A group of state attorneys general, led by Missouri, is currently suing the Food and Drug Administration (FDA) over its deregulation of the drug, arguing that abortion drugs have been “flooding states like Missouri and Idaho [where abortion is otherwise regulated] and sending women in these states to the emergency room.”

In addition, Texas Attorney General Ken Paxton recently filed a lawsuit against an abortionist in New York, alleging that she illegally provided abortion drugs to a woman in Texas, which killed the unborn child and caused serious health complications for the mother.”

Sadly, as Mr. McKeown writes:

President-elect Trump has committed to keeping abortion pills accessible during his second term — a major disappointment for pro-life advocates, who have urged Trump to use the FDA’s power to enforce a Comstock Act prohibition on the delivery of “obscene” and “vile” products through the mail, which includes the delivery of anything designed to produce an abortion.”

CONCLUSION

As I wrote in my June 16, 2024 blog “The Supreme Court Rejects Challenge by Pro-life Doctors on Abortion Pill“:

“As Life News reported on June 13, 2024:

“The Supreme Court on Thursday rejected a challenge to the abortion pill mifepristone, meaning the abortion drug will be widely available to continue killing babies and injuring doctors nationwide.

The 9-0 decision says the pro-life doctors who brought the case do not have standing – they were not injured, and so the court does not intervene. That’s even though they sued on behalf of women who were injured by the abortion drug by the thousands – including women who have been killed.” (Emphasis added)”

I have a personal interest in this because I had an unwed daughter who became pregnant and started bleeding without telling me because of embarrassment.

She went to a local ER, where the doctors said she was just having a miscarriage and sent her home.

When the pain and bleeding increased, she called me. I took her back to the ER to demand an ultrasound.

As I suspected as a nurse, her pregnancy was ectopic and emergency surgery was performed.

Afterward, the surgeon showed me the picture he had taken (unasked) during the surgery to remove the then-deceased first-trimester baby, my grandchild. The picture was personally so sad to see but I was comforted that the surgeon cared enough to take a picture of this tiny person and show respect.

We need more respect and help for women with an unexpected pregnancy and their babies than a pill without medical safeguards!”

Related

“Safer Than Tylenol” is Deliberate Medical Abortion Disinformation February 26, 2023

Planned Parenthood Sues Kansas to Challenge a New State Law Requiring Abortion Reversal Information to be Provided Before Abortion June 12, 2023